simulation: integrating interactive learning experiences...
TRANSCRIPT
Simulation: Integrating interactive learning experiences into the
nursing curriculum
Suzanne H. Campbell, PhD, RN, IBCLC
Associate Professor, UBC School of Nursing,
University of British Columbia, Vancouver, BC, Canada
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Welcome!
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Photo Credit: http://www.traveltop.net/wp-content/uploads/2012/05/banff-national-park-alberta-canada1.jpg
DisclosureSuzanne Hetzel Campbell PhD, RN, IBCLC
• Royalties Springer Publishers, Inc. Co-editor Simulation Scenarios for Nursing Educators: Making it Real 3rd Ed., 2018.
• Royalty Jones & Bartlett Learning, Co-editor Core Curriculum for Interdisciplinary Lactation Care, 2018.
• Sit on Editorial Board of Clinical Simulation in Nursing
• Sit on Advisory Board of LiquidGoldConcept, Inc.
• Sit on Board of Directors of CanHealth International
• Canadian Association of Schools of Nursing (CASN/ACESI) Course Instructor, Canadian Simulation Nurse Educator Certification Program (Modules 2 & 3)
• I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation
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Objectives
• Share a “state-of-the-science” perspective to identify synergies for your program planning
• Differentiate the use of simulation for technical and non-technical learning: clinical skill, teamwork, conflict resolution, leadership and role development;
• Review health professional educations use of simulation;
• Analyze the substitution of clinical practice with other methods of learning (on-campus vs off-campus);
• Examine how simulation is being standardized and evaluated; and
• Compare and contrast the advantages and challenges of integrating simulation into the curriculum.
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The 2010 Lancet Commission Report:
Blueprints for 21th Century Health Professional Education
INSTITUTE OF MEDICINE of the National Academies HiOA Norway Faculty Workshop 05 March
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Education of Health Professionals for
the 21st Century (2010)
Health Professionals for a New Century: Transforming Education to Strengthen Health
Systems in an Interdependent World*A Global Independent Commission
• Educate all health professionals:
– as members of interdisciplinary teams,
– emphasizing evidence-based practice,
– quality improvement approaches, and
– informatics*Julio Frenk and Lincoln Chen. "Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World." The Lancet 376, (Dec 4, 2010): 1923-1958.
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Top 10 Changes in Nursing in last ½ Century! (Barron McBride, 2011, p. 166-167)
1. Nursing not one kind of job (leadership not discipline specific)2. Growing global acceptance that nursing leadership is necessary
for development of safe practice environments, quality care3. Informatics revolution – practice, research, education – not time or place
bound4. Emphasis now on OUTCOMES (rather than process) – decision making
requires data5. Centers of nursing excellence -> consortium arrangements across
institutional boundaries6. Research base of nursing visible – doctoral programs, post-doctoral
training, institutes of nursing research, research societies7. Advanced-practice nursing established at graduate level – accepted by
public, specialties, and certification8. Nursing students – diverse age, gender, race, learning style --- better
reflecting the population served9. Articulation across levels of nursing increasingly possible and user-friendly10.Nursing literature and infrastructure greatly expanded – journals,
standards, competencies, and policy statements
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Paradigm Shift in Nursing Education
• Effective use of nurses based on their levels of
– Knowledge
– Education
– Skills
• Configuration of the nursing workforce –succession planning
• Enhancing the knowledge base of nursing to bring it in line with other professions (BSN)
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WHO Collaborative Practice Learning
Domains• Teamwork
• Roles and responsibilities
• Communication
• Learning and critical reflection
• Relationships with and recognizing the needs of
the patient
• Ethical practice
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World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Care. Geneva, World Health Organization. Retrieved from http://www.who.int/hrh/resources/framework_action/en/
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Evolving Use of Simulation
Across industries, simulation technologies have evolved from World War I (wooden horse
simulator) to latest aircraft simulators being used by NASA
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• Photo wooden horse simulator & NASA
Modern era of simulation technology in health care – 1960’s Norway!
• Bjorn Lind – a Norwegian anesthesiologist persuaded Asmund Laerdal, to make Resusci-Anne – CPR mannequin (1960s)
• Earlier 1874 advocates for use of skeletons in Schools of Nursing
• 1906 – Mrs. Chase (Hartford Hospital, SoN, Connecticut US) full-body static mannequin for practicing injections/procedures
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Prevalence of Simulation Globally
Courtesy Foisy-Doll & Leighton, SCORS presentation 2017, slide 6our text here
Simulation Statistics• NCSBN Study - NCSBN conducted a landmark, national,
multi-site, longitudinal study of simulation use in prelicensure nursing programs throughout the country. Collaborating with learning institutions across the U.S., NCSBN embarked on a research initiative exploring the role and outcomes of simulation in pre-licensure clinical nursing education.
• The study provides substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses under conditions comparable to those described in the study.
https://www.ncsbn.org/685.htm
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Simulation vs Case-Based Learning
• Similarities:– Identify objectives for learning
– Provide a beginning “story” with key information
– Focus on critical thinking
– Fluid/dynamic process – no “right” answer
• Differences: Simulation/Health care scenarios– A method of teaching for unpredictable future events
– Variety of confounding variables & quick timeframe
– More individually focused vs. system/organization
– Prioritization of actions – misstep = adverse event
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Flexible Learning Opportunities
• Web-based instruction enhanced - modules with interactive learning and testing options
• Hybrid Simulation
• Outside preparation that augments class
• Classroom – small and large groups, individual response systems for interactive learning (clickers, PollEverywhere, Zoom)
• Clinical/lab = High-stakes testing/Capstones
• Virtual reality – HMD, examine patient, clinic, etc
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Identifying Curricular Fit
• Curriculum – concept-based, specialty-specific
• Key experiences –
– Technical skills: asthma, hemorrhage, CPR, hypoglycemia, deteriorating patient
– Non-technical skills: communication, team-work, therapeutic relationship – power-sharing, empathy, and trust/rapport building
• Reality-based: faculty expertise, lab resources, time management, substitution for clinical hours
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Assessing Organizational Readiness
• SCORS – Simulation Cultural Organizational Readiness Survey (Foisy-Doll & Leighton, 2017) https://sites.google.com/site/scorsfile/home
• Faculty buy-in and professional development – identification of champions
• Student request - expectations
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Assessing Program Objectives
• Mission & Vision of your school, fit with university and community
• Describe what your graduate will look like
• Identify theoretical frameworks underlining your approach to teaching and clinical practice
• Outline professional development
• List outcome competencies for program –match with country Registered Nurse licensing
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Theories Guiding Simulation Case Development
• Blooms Taxonomy – to guide objective development (transition over time)
• Bandura’s Theory of Self-efficacy – to increase confidence for skill development
• Benner’s (1984) – Novice to Expert (here)• Kolb’s (1984) Experiential Learning Theory (here)• Schön’s reflection-in-action/reflection-on action (1983)• NLN/Jeffries Simulation Framework• Daley & Campbell’s Framework for Simulation Learning
in Nursing Education © - to provide knowledge translation & mobilization for theory into practice
• (17 years, average time for best practices to translate into hospital practice)
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Evolution: Comparison of Bloom’s Original (1956) and Bloom’s Revised (2001)
Taxonomies with QSEN KSAs
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Domains of Learning
• Original Bloom’s Taxonomy (1956)
• Cognitive
• Psychomotor
• Affective
Knowledge Dimension
•Revised Bloom’s Taxonomy (2001)
•Factual knowledge
•Conceptual Knowledge
•Procedural knowledge
•Metacognitive knowledge
QSEN Competencies
• The Quality and Safety Education for Nurses (QSEN) Project (2005 – 2012)
• Knowledge
• Skills
• Attitudes
Anderson & Krathwohl, 2011; Bloom, 1956; Cronenwett et al., 2007
Clinical Judgment
Critical Thinking Problem SolvingPsychomotor
SkillsClinical
Reasoning
Nursing skill development and clinical judgment model (International Nursing Association for Clinical Simulation and
Learning)
The Experiential Learning Cycle*(here)
• Kolb's experiential learning style theory is typically represented by a four stage learning cycle in which the learner 'touches all the bases':
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“Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38).
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CultureIndividual
Experiences
Learner brings to learning:
Framework for Simulation Learning in Nursing Education
Digital culture
Improved
Outcomes
Translation to
practice
Think Critically
Communicate
Effectively
Intervene
TherapeuticallyS
Foundational
Knowledge
Vigilance
Learning to learn
Human dimension
Integration Application
Caring
Failure to
Rescue
Feed-
back
loop
Translation
to practice
Improved
Outcomes
Safety
Excellence
Reflective
Practice
© Daley & Campbell
(2008) Framework for
simulation learning in
nursing education.
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Examples of simulation pedagogy
integration for IPE• Integration throughout the curriculum
– Multiple opportunities for IPE – passport; medication reconciliation; patient-handovers; teamwork in trauma scenarios
– Health mentor model
• Competency-based testing at various points– Use to assess student competencies individually with evaluation criteria
and student goals focused on IPE
• Concept-based across the curriculum– Develop scenarios which can be used to bring together concepts that fit
many specialty areas and levels of students (e.g. medication reconciliation, ethics, informatics, communication, cultural humility)
• Scherer et al (2013) found IP simulation fostered collaboration between nursing & medical students on 3 subscales of the Readiness for Interprofessional Learning Scale: teamwork & collaboration, professional identity, & roles & responsibilities
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Postpartum Hemorrhage Still Leading Cause of
Maternal Death
35%
18%9%
8%1%
11%
18%
CAUSES OF MATERNAL DEATH
Haemorrhage Hypertension Unsafe abortion Sepsis
Embolism Other direct Indirect
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Source: http://www.countdown2015mnch.org/documents/2012Report/2012-Complete.pdf
• Leading cause of maternal
mortality: 35% of all maternal
deaths
• About 14 million women around
the world suffer from PPH every
year
• Maternal Mortality Ratio (MMR)
has roughly halved between 1990
(400 per 100,000 live births) and
2010 (210 per 100,000 live births)
• However, MMR is
disproportionately high in
developing countries (240 per
100,000 live births) than
developed countries (16 per live
births)
http://www.who.int/medicines/areas/priority_medicines/BP6_16PPH.pdf
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Undergraduate NursingSimulation Scenario Prep
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Identifying Simulation Scenarios
4.3 kg infant of a
diabetic mother is
experiencing
hypoglycemia and
respiratory distress,
potentially life-
threatening. (photo)
Adolescent that was
admitted with the
diagnosis of recurrent
leukemia, for which
there was no curative
treatment (photo)
Post-partum
hemorrhage –
high maternal
mortality rates.(photo)
1st trimester bleeding –
spontaneous abortion,
gestational trophoblastic
disease; three emergency
deliveries, high risk of
maternal and/or fetal
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Gaps in Nursing Simulation Research
Mariani & Doolen (2016)* identified the following gaps:
(a) outcomes,
(b) simulation design/setting,
(c) participants/facilitators, and
(d) research rigor.
Greatest obstacles: Time, resources, and support • Mariani, B., & Doolen, J. (2016, January). Nursing simulation research: What are the perceived gaps? Clinical Simulation in
Nursing, 12(1), 30-36. http://dx.doi.org/10.1016/j.ecns.2015.11.004.
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The Elephant in the Room
• Faculty Professional Development
– Lack of time release – added on content
– Fee structures – do not support lab resources and IT, lab staff support
– How are we working with faculty to prepare them?
• Continuing Education
• Competency requirements
• Evaluation
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http://www.funicebreaker.com/wp-content/uploads/2012/12/elephant_copy_animal-1969px.png
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Models for Integrating Simulation in the curriculum
• Map out curriculum identifying key competencies
• Create climate for faculty professional development – identify “Champions”
• Develop scenarios according to INACSL Best Practice StandardsSM
• Identify combination of teaching strategies use according to programs context
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Standard IX: Simulation DesignTo achieve optimal outcomes, simulation design should consider the following elements:1. Needs assessment2. Measurable objectives3. Format of simulation4. Clinical scenario or case5. Fidelity6. Facilitator/Facilitative approach7. Briefing8. Debriefing and/or feedback9. Evaluation10. Participant preparation11. Test of the design (Lioce et al., 2015, p. 310).
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Scenario Development
• Working in teams
• Focusing outcomes – clinical, team, leadership
• Coordinating the event – date, time, place, participants
• Small scale: in situ – e.g. Code in ER, PPH code in OB
• Large scale: disaster planning – include first responders, government, health care practitioners, and students
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Evidence-based practice (EBP) baseline for simulation scenario development
During simulation – Use current Evidence-Based Practice (EBP) guidelines
• Introduce EBP guidelines (or evidence-informed guidelines)
• Implement EBP guidelines throughout the scenario (incorporate as part of assessment check-list)
• Reinforce EBP guidelines during de-briefing or second-run of the scenario
• Assess for transfer to clinical skills by assessing on clinical evaluation tools
• Enhance synergy between classroom & clinical practiceHiOA Norway Faculty Workshop 05
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Future of Health Care Professional Education
• Simulation
• Web Based Learning - Virtual Simulation – Virtual Clinical Excursions TM (VCE) Elsevier
– Serious Gaming – e-Baby TM Serious Game
– Multiplayer Virtual Worlds
– Single User Products: CliniSpace TM (here); TINA TM; Second Life TM; ArchieMD TM
• Virtual RealityHiOA Norway Faculty Workshop 05 March 2018 SHCampbell
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Virtual Simulation – Future?
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• Photo of virtual reality glasses
Digital technology: VR, AR, Green-screen
• Green-screen technology: static photo or dynamic video as backdrop for illusion (e.g. car accident scene, University of Johannesburg)
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Photos: SHCampbell, University of Johannesburg, South Africa 9/20/2017
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Photos: SHCampbell, University of Johannesburg, South Africa 9/20/2017
Standardization Process
Contributing factors:• INACSL Best Practice Standards: Simulation SM
(2016)– Increased confidence in reliability of scenarios,
facilitation, teaching, and evaluation methods– NLN-INACSL Debriefing Across the Curriculum
• Society for Simulation in Healthcare (SSIH) Dictionary– Importance of speaking the same language
• Repository of Instruments Used in Simulation Research INACSL
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Next steps
I. Many opportunities to bridge the education- practice gap
and create innovative learning: need standardization,
assessment, evaluation
II. Critical Reflection of Learning – Debriefing depends on
initial objectives
III. Proceed with caution and use of theory in the
development of policies around clinical hours/
substitution – focus on competencies and measurable
learning outcomes
IV. Integrate incrementally – combine methodologies for best
return on investment
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Tell me more about your toolkit!
Thank you!
Contact Information:
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References - IPEInterprofessional Education - Key papers:
• A National Interprofessional Competency Framework. Canadian Interprofessional Health Collaborative, 2010. http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf
• Core competencies for interprofessional collaborative practice: Report of an expert panel. Interprofessional Education Collaborative, 2011. http://www.aacn.nche.edu/education-resources/IPECReport.pdf
• World Health Organization (WHO). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization, 2010. Retrieved June 20, 2011 from: http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf
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References-IPE• IPEC (2011). Core Competencies for Interprofessional Collaborative Practice: Report of an Expert
Panel. Retrieved from http://www.aacn.nche.edu/education-resources/ipecreport.pdf.
• Frenk, J. and Chen, L. "Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World." The Lancet 376, (Dec 4, 2010): 1923-1958.
• Maxfield, D., Grenny, J., McMillan, R., Patterson, K. & Switzler, A. (2005). Silence Kills: The Seven Crucial Conversations in Healthcare. Retrieved from http://www.aacn.org/aacn/pubpolcy.nsf/Files/SilenceKillsExecSum
• A National Interprofessional Competency Framework. Canadian Interprofessional Health Collaborative, 2010. http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf
• Quality and Safety education for Nurses: QSEN. Retrieved December 1st, 2011 from http://www.qsen.org/about_qsen.php
• World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Care. Geneva, World Health Organization. Retrieved from http://www.who.int/hrh/resources/framework_action/en/
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References - Simulation• Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulation for
novice nursing students: Communication, confidence, clinical judgment. Nursing
Education Perspectives, 30, 79-82.
• Barrett, H.C. (2006). Researching and evaluating digital storytelling as a deep learning
tool. In C. Crawford et al. (Eds.), Proceedings of Society for Information Technology & Teacher
Education International Conference 2006, (pp. 647-654), Chesapeake, VA: AACE.
• Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo
Park: Addison-Wesley, pp. 13-34.
• Campbell, S.H. (2010). Chapter 8, Clinical simulation. In K.B. Gaberson and M.H.
Oermann, Clinical teaching strategies in nursing (3rd ed). (pp. 151-181). New York: Springer
Publishing Company.
• Campbell, S.H. (2013). Chapter 14 Obstetric Emergency: Post-partum hemorrhage. In
S.H. Campbell & K. Daley (eds) Simulation Scenarios for Nurse Educators: Making it REAL
(2nd Ed). (pp. 137-148). New York, N.Y.: Springer Publishing Company, Inc.
• Campbell, S.H. & Daley, K. Eds. (2018). Simulation scenarios for nursing educators: Making it
real. (3rd ed). New York, N.Y.: Springer Publishing, Inc.
• Clapper, T. C., & Ng, G. M. (2013, August). Why your TeamSTEPPS program may not
be working. Clinical Simulation in Nursing, 9(8), e287-e292.
doi:10.1016/j.ecns.2012.03.007.HiOA Norway Faculty Workshop 05 March
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References - Simulation• Daley, K. & Campbell, S.H. (2018). Chapter 44 Framework for Simulation Learning in
Nursing education. In S.H. Campbell & K. Daley (eds) Simulation Scenarios for Nursing
Educators: Making it real. (3rd Ed) (pp. 13-18). New York, N.Y.: Springer Publishing
Company, Inc.
• Decker S. I., Anderson M., Boese T., Epps C., McCarthy J., Motola I., Palaganas J., Perry
C., Puga F., Scolaro K., & Lioce L. (2015, June). Standards of best practice: Simulation
standard VIII: Simulation-enhanced interprofessional education (sim-IPE). Clinical
Simulation in Nursing, 11(6), 293-297. http://dx.doi.org/10.1016/j.ecns.2015.03.010.
• Jeffries, P. (2005). A framework for designing, implementing, and evaluating: Simulations
used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103.
• Kaakinen, J., & Arwood, E. (2009). Systematic review of nursing simulation literature for
use of learning theory. International Journal of Nursing Education Scholarship, 6, 1.
• Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C. (2010). A review of currently
published evaluation instruments for human patient simulation. Clinical Simulation in
Nursing, 6(1), e25-35. doi: 0.1016/j.ecns.2009.08.004
• Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development
(Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.
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References - Simulation• Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015, June). Standards
of best practice: Simulation standard IX: simulation design. Clinical Simulation in Nursing, 11(6),
309-315. http://dx.doi.org/10.1016/j.ecns.2015.03.005.
• Mariani, B., & Doolen, J. (2016, January). Nursing simulation research: What are the perceived
gaps? Clinical Simulation in Nursing, 12(1), 30-36. http://dx.doi.org/10.1016/j.ecns.2015.11.004.
• Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., Sando, C. R., & Borum, J.
C. (2013, June). Standards of Best Practice: Simulation Standard I: Terminology. Clinical
Simulation in Nursing, 9(6S), S3-S11. http://dx.doi.org/10.1016/j.ecns.2013.04.001.
• Mikasa, A. W., Cicero, T. F., & Adamson, K. A. (2013). Outcome-Based Evaluation Tool to
Evaluate Student Performance in High-Fidelity Simulation. Clinical Simulation in Nursing, 9(9),
e361-367. doi: 10.1016/j.ecns.2012.06.001
• Murdoch, N. L., Bottorff, J. L., & McCullough, D. (2013). Simulation Education Approaches to
Enhance Collaborative Healthcare: A Best Practices Review. International Journal of Nursing
Education Scholarship, 11, 307. doi: 10.1515/ijnes-2013-0027
• Pagano, M., O’Shea, E., Campbell, S., Currie, L., Chamberlin, E., & Pates, C. (2015). Validating
the Health Communication Assessment Tool (HCAT). Clinical Simulation in Nursing, 11, 402-410.
• Scherer, Y. K., Myers, J., O’Connor, T. D., & Haskins, M. (2013, March). Interprofessional
simulation to foster collaboration between nursing and medical students. Clinical Simulation in
Nursing, Vol(X), xx-xx. http://dx.doi.org/10.1016/j.ecns.2013.03.001.
• Young, P.K. (2004). Trying something new: Reform as embracing the possible, the familiar, and
the at-hand. Nursing Education Perspectives, 25, 124-30.HiOA Norway Faculty Workshop 05 March 2018 SHCampbell
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